We examined HIV-1 resistance in children failing first-line and second-line antiretroviral therapy in South Africa, all with clade C virus. Those exposed to full-dose ritonavir had multiple protease resistance mutations. Nineteen percent had wild-type virus. Appropriate antiretroviral therapy sequencing in sub-Saharan African children is essential for prolong treatment options.
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From the *Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa; †Division of Infectious Diseases, Massachusetts General Hospital; ‡Harvard Medical School; §Medical Practice Evaluation Center, Massachusetts General Hospital; ¶Division of Infectious Diseases, Brigham and Women’s Hospital; ‖Division of General Medicine, Massachusetts General Hospital; and **Department of Health Policy and Management, Harvard School of Public Health, Boston, MA.
Accepted for publication December 11, 2012.
This work was completed through support from an ARRA PEPFAR supplement to National Institute of Allergy and Infectious Diseases (NIAID) R01 AI085736 to K.A.F., K01 AI078754 and IMPAACT network (NIAID and National Institute of Child Health and Human Development) to A.L.C. and by a Virology Specialty Laboratory subcontract from the AIDS Clinical Trials Group (National Institutes of Health grant UM1 AI068636) to D.R.K. The authors have no other funding or conflicts of interest to disclose.
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Address for correspondence: Catherine Orrell, MB ChB, Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town Faculty of Health Sciences, Anzio Rd, Observatory, Cape Town, South Africa 7925. E-mail: firstname.lastname@example.org.